Clarification Needed on Medical Notes
At 18 years old (assigned female at birth), I recently opened my NHS app to review my medical records added by my GP. Unfortunately, the oldest notes I can access only date back to February 2023, which is quite frustrating. I am a lifelong citizen of the UK and I have been diagnosed with autism and chronic migraine without aura. While checking my file, I came across a note from December 2023, which is only a month after my diagnosis regarding chronic migraines. The note included a coded entry: *“Pulmonary embolus” or “pulmonary infarction” (G401.) under neuro, while I am on propranolol.* This entry is unfamiliar to me, and I’m uncertain whether it implies that I have experienced one of these conditions in the past, or if it serves as a warning regarding potential risks. To provide some context that might be pertinent: I have dealt with respiratory and cardiac issues since I was around 9 or 10 years old. Running, which I loved to do, started to become increasingly difficult due to shortness of breath. Consequently, I was prescribed inhalers that provided temporary relief. When I was in my early teens, my high school expressed concern due to a persistent barking cough that flared up during colder months or seasonal shifts. They suspected it could be croup, which seemed illogical since I had this cough since I was only 4 years old. After an X-ray of my lungs, we never received any definitive results, other than the fact that they were unable to determine the cause of my cough. This cough continues to affect me, including during illness. The lung X-ray was the only formal examination conducted specifically for my respiratory issues, although I had another X-ray done about a year earlier. As far as mine and my mother’s recollection goes, these were the only times my lungs were assessed. It's also around this age that my migraines intensified, transforming into a chronic condition. I was meant to undergo tests for asthma but these were never carried out. Thus, my main questions are: Does the recent note indicate that I have previously had a pulmonary embolism or infarction, or is it a precaution regarding future risks? How might my migraines and current medication relate to these pulmonary conditions? I thought it would be best to ask here before reaching out to my GP tomorrow, as I would prefer to avoid unnecessary anxiety tonight. Thank you for your help!
Answers (1)
4/2/2025, 7:30:59 PM
OpenHealth AI
It's understandable to feel anxious and confused after discovering medical notes that may not be clear. Let's break this down to address your concerns.
Main Points:
- The coded entry you encountered regarding "pulmonary embolus" or "pulmonary infarction" is likely a precautionary note rather than indicating that you have experienced these conditions.
- Your chronic migraines and the medication you are taking may have some relation, but they generally do not directly cause pulmonary issues.
Explanation:
-
Coded Entries: In medical records, coded entries like "pulmonary embolus" (a blockage in a lung artery) or "pulmonary infarction" (death of lung tissue due to lack of blood supply) may appear for various reasons, including assessing risk factors or documenting potential concerns based on your medical history. This does not necessarily mean you have had these conditions.
-
Relation to Migraines and Medication: Propranolol is often prescribed to help manage migraines, but it is also a beta-blocker that affects blood circulation and can be associated with respiratory symptoms in some patients. Chronic migraines can occur independently of respiratory disorders.
-
Respiratory Concerns: Given your history of respiratory and cardiac issues, it is essential that these are monitored, especially since you have experienced shortness of breath and a persistent cough. While it’s good that you are aware of these things, it’s crucial to discuss them with your GP for clarification.
Next Steps:
-
Document Your Concerns: Before your appointment, write down any concerns you have about the coded entry and how it might relate to your overall health, including your migraines and respiratory issues.
-
Prepare Questions for Your GP: Specifically ask:
- Does the note about "pulmonary embolus" indicate a past event or is it a general precaution?
- How does my current medication affect my respiratory health?
- Would further testing (like a lung function test or asthma assessment) be appropriate given my history?
-
Monitor Symptoms: Keep track of any changes in your breathing, cough, or migraine frequency/intensity. This information can help your GP make informed decisions.
-
Manage Anxiety: Consider techniques to manage anxiety while awaiting your appointment, such as deep breathing exercises, mindfulness, or enjoyable activities that can distract you.
It's great that you’re reaching out for clarification and support. You're taking an important step in being proactive about your health, and I encourage you to discuss these points with your GP for tailored advice and reassurance.
Related Questions
Concerns about HSV Transmission During Nasal Suctioning for My Baby
Recently, I experienced my first cold sore at the age of 29, appearing at the edge of my lower lip. With a three-month-old infant, I have been particularly cautious, believing that the herpes simplex virus (HSV) is transmitted solely through direct contact. I made sure to avoid kissing my baby and kept my distance. On her three-month birthday, she woke in the early morning with significant nasal congestion. Feeling exhausted, I instinctively reached for the Frida nasal suction, my usual go-to in such situations. While using the device, I made sure my cold sore was not in contact with it. Typically, I only use the suction in her nostrils, afterward blowing air onto my hand to check for any mucus and then continuing the process. However, as I performed this task, I began to question whether I was potentially spreading the virus; my research revealed that HSV can indeed be transmitted through saliva. Although most of my usage was suctioning, I realized I had occasionally blown into the tube to assess its effectiveness before resuming suction. Naturally, I'm feeling anxious and regretful for not thoroughly considering the risks involved. Additionally, I learned that my illness may have contributed to my cold sore, and now I suspect my baby may also be coming down with something—her first cold has me quite worried. I took precautions by wearing a mask, and throughout the week, she seemed unaffected. Being a breastfeeding mother, I hope she has received ample antibodies to help her. I would greatly appreciate any insights on whether I need to be alarmed or if there are specific signs I should monitor. Thank you for your assistance!
Dismissed as a Patient After 26 Years
For the past 26 years, I’ve been a patient at the same medical office, practically since the moment I entered this world (or rather, since I began my existence). Admittedly, I did transition from a pediatrician to a general practitioner when I turned 18, but I’ve mainly seen the same doctors throughout my life, including a general physician and a sports medicine specialist. During this extensive period, I have only missed a couple of appointments—perhaps just two in total—which seems quite reasonable considering I’ve had numerous check-ups and consultations due to various health issues, largely stemming from accidents and injuries. It’s not uncommon for someone like me, who tends to be accident-prone, to have over a hundred visits in nearly three decades. However, I recently discovered that I’ve reportedly missed three appointments in the span of six months. This unexpected revelation is frustrating, as those missed appointments occurred while I was recovering from orthopedic surgery following a significant work-related accident—I tumbled two stories off a ladder, highlighting my tendency for mishaps. The appointments I failed to attend were routine check-ups with my general practitioner, my sports medicine doctor, and a blood test. Unfortunately, they all coincidentally fell around the same period just after my surgery. I learned about the need for the surgery only a few weeks ahead of these scheduled appointments, and post-surgery, mobility was a challenge. I had asked my husband to cancel them on my behalf, but he neglected to do so—an oversight we share. While I take some responsibility for not ensuring the calls were made, I was heavily medicated with prescribed pain relief at the time. Despite my generally good attendance record, this series of missed appointments led to my dismissal as a patient. Today, when I contacted the office to request a refill for a chronic medication unrelated to the surgery, I was informed that I can no longer receive care there, as I was discharged as a patient back in early January. This came as a shock, especially since they had filled a different prescription for me just weeks ago without any issues. It raises the question: how can they discharge me and then assist with a prescription shortly before? I’ve been on the same medication for over seven years, and I am not asking for anything out of the ordinary. If they want to sever ties after 26 years, I’m willing to find another provider, but it feels absurd to deny me vital medication after such a long-standing relationship. Is this a common practice? When I explained my situation—politely and respectfully—the response was still a firm refusal to refill my prescription. My discussions were limited to administrative personnel, leaving me at a loss about my next steps. I’ve always been a reliable patient, with the exception of these recent three appointments occurring immediately after the surgery. The urgency of my medical needs can’t be understated: I am in need of key prescriptions and follow-up care due to significant health concerns from my recent injury, numerous corticosteroid injections, and a positive result from a cancer screening test. Although statistics suggest the probability of a false positive at my age, it still necessitates thorough follow-up, especially given my family's history of this condition. For the past week, I’ve reached out daily, always with courtesy, yet I’ve received no resolution, just the run-around among various office staff. They mentioned they sent me a letter to inform me of my dismissal, yet I never received a call, email, or any subsequent communication. One single letter does not suffice to terminate a patient’s long-term relationship with their medical practice, especially when it involves critical prescriptions and post-surgery care. Is this standard protocol? I cannot stress enough that I am not embellishing my situation. With an almost flawless attendance record and a recent misstep due to surgical recovery, being abruptly cut off feels excessive. I truly appreciate my general practitioner, need my medication, and face a myriad of concerns—from continuity of care to other pressing health issues—which makes this entire experience deeply troubling and perplexing.
Uncertainty Surrounding My Health Incident
I am a 15-year-old girl currently battling a cold, and I also have a confirmed diagnosis of Ehlers-Danlos syndrome. Additionally, I suspect I may have POTS, although that's not officially confirmed. Earlier today, I got up to visit the bathroom, which requires navigating around twenty steps from the living room. As I stood up, I noticed my vision starting to blur, but that’s a familiar sensation for me, so I didn’t think anything was amiss. Upon reaching the bathroom, my eyesight faded to complete darkness. Losing my sight entirely isn’t unusual for me, and while frustrating, I merely found it bothersome rather than alarming. Once inside, I turned on the light, and although I couldn’t see it illuminating the room, I heard the click of the switch, indicating it was on. I then attempted to locate the sliding door to close it. However, I misjudged the doorway completely on my first try. I felt it was odd, yet I dismissed it and tried again, but I encountered the same issue. After my second attempt, I experienced significant trembling in my limbs, so intense that I realized I was on the verge of falling. To prevent that, I quickly lowered myself to the floor, remaining blind to my surroundings. After about five seconds, my vision began to return, and I noticed my legs were still shaking. A few seconds later, the shaking subsided, and I regained control over my body. I stood up right after, feeling relatively assured that it wouldn’t happen again, but I opted to sit for safety's sake. This event occurred just a couple of hours ago, and thankfully, it hasn't recurred. Although my vision tends to dim when I stand, that is a typical occurrence for me, and I’ve since retained partial sight. I did not lose consciousness during the incident and have clear memories of the entire experience, without confusion or disorientation afterward. Notably, epilepsy runs in my family; my aunt has it, and my mother’s cousin experienced several seizures a few months back, although he hasn’t had any recently. Personally, I have never fainted, though I’ve come close multiple times. It’s important to mention that I’ve never experienced a seizure before, and I remain uncertain whether what transpired was a seizure or something different altogether.
Navigating the Fine Line Between Anxiety and ADHD: Seeking Insights on Dual Diagnoses
At 28 years old, I find myself seeking a better understanding of whether my primary challenges stem from anxiety, ADHD, or perhaps a combination of both. From a young age, I have experienced difficulties with focus, restlessness, impatience, and discomfort in social situations. These challenges didn’t suddenly arise in adulthood; instead, I recall struggling to pay attention in class, often needing to reread material multiple times. I frequently felt as if my brain was racing, easily becoming overwhelmed by background noise, conversations, or any form of pressure. Currently, reading continues to be a struggle, as I often rush through texts without fully absorbing the information. The same pattern emerges in tasks like problem-solving and programming—I require repeated attempts to truly grasp the concepts. In addition, I have dealt with considerable anxiety throughout my life, characterized by fears of being judged, persistent worry, heightened alertness, compulsive behaviors like constant checking, and physical manifestations such as agitation and a racing heart. After consultations with various healthcare professionals, I was diagnosed with anxiety, leading to medication that I began taking about a year ago. This treatment alleviated some fears and allowed me to function better, yet the fundamental challenges related to focus, motivation, impatience, and mental agitation persisted. When I abruptly halted the medication, my anxiety symptoms returned with a vengeance. My current psychiatrist initially viewed my situation as stemming from anxiety and traits of OCD, recommencing treatment for anxiety. However, by our third appointment, considering my symptoms have been present since childhood and the anxiety treatment only provided partial relief, he proposed that ADHD might be the root issue, suggesting that anxiety could possibly be a secondary concern. Thus, I am now prescribed medications addressing both anxiety and ADHD. What complicates my understanding is the significant overlap in symptoms: - Persistent mental restlessness and a sense of being "on edge" - Challenges in maintaining attention and completing tasks - Low drive, tendencies to avoid tasks, and procrastination - Social anxiety coupled with fear of judgment - Feeling overwhelmed by sounds, conversations, or stressors - Anxiety medications mitigate fear but do not resolve focus issues or cognitive restlessness I seek clarity on the following questions: 1. How do medical professionals distinguish between adult ADHD and anxiety disorders when the symptomatology is so intertwined? 2. What methods can help determine if ADHD is the primary issue rather than anxiety taking precedence? 3. Is it typical for ADHD, particularly when undiagnosed since childhood, to predominantly manifest as anxiety in adulthood? 4. How can one assess whether ADHD medication is effectively making a difference, especially with concurrent anxiety symptoms? Any professional insights on delineating these conditions in adults—especially when their roots appear to date back to childhood—would be immensely beneficial. Thank you for your attention and assistance.
Severe Pain and Dryness in Hands and Toes: A Continuing Struggle
Subject: Ongoing Hand and Foot Discomfort – Seeking Insight Greetings, medical professionals, For the past several months, I have been dealing with distressing symptoms affecting my hands and feet, and I'm eager for some clarity. I have appointments lined up with an allergist and a dermatologist, but I won’t be able to see them for a few months. My previous tests for autoimmune conditions came back negative, though my ESR levels were elevated. Currently, I’m suffering from significant pain in my toes, resembling joint discomfort. Additionally, both my hands and feet appear swollen, especially with pressure applied. Some fingers have remained swollen for several weeks. According to my recent lab results: - A Complete Blood Count (CBC) revealed chronic anemia, although it has improved since the last test. - A Comprehensive Metabolic Panel (CMP) indicated slightly elevated liver enzymes, with plans to recheck in three months. - However, my Glomerular Filtration Rate (GFR) indicated normal kidney function, while ESR results suggest mild inflammation. - Further laboratory results are pending. Moreover, I have noticed extreme dryness in my hands, characterized by peeling and cracking skin. Random bumps have developed on my knuckles, and the itchiness has become unbearable. The sequence of symptoms seems to transition from intense itching to swelling and redness, ultimately leading to dryness, which has persisted since November. I received a seven-day course of steroids for my asthma, which initially facilitated improvement but the symptoms returned, even exacerbated, once the treatment ended. Currently, the issues have spread to my feet, with severe pain specifically in my big toes and discomfort in all of my fingers. My left index finger has been particularly troubling; it became swollen and limited in movement after I attempted to point at something. This relentless cycle of pain has been incredibly draining. Even light pressure causes discomfort due to the pain within my skin and bones. I've experimented with prescription steroid creams, cortisone treatments, and various over-the-counter ointments, but none have provided relief. Since mid-December, breathing has also posed challenges for me. Although I have a rescue inhaler, I haven’t been able to utilize my maintenance inhaler as I am currently nursing, due to potential transfer into breast milk. Additionally, I should mention that the previously mentioned index finger has shown signs of nail pitting near the cuticle, which has also become inflamed, dry, and itchy, alongside my other cuticles. This is quite unusual for me, as I have never experienced dry hands before this episode. I have not introduced any new soaps or cleaning agents into my routine. Any insights or recommendations regarding these symptoms would be greatly appreciated as I navigate this challenging time.